Polio, tetanus, diphtheria, typhoid, hepatitis A and other diseases carried in the food and water are all a risk in undeveloped countries where sanitation is sometimes primitive. While various vaccinations will protect you against many of these diseases, there is no substitute for good hygiene.
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Most people are immunized against polio, tetanus and diphtheria in infancy. This protection, however, must be renewed every ten years with a booster vaccination.
Typhoid is caught through the consumption of food or water contaminated with Salmonella Typhi. Once ingested, this bacterium multiplies quickly; and even if you recover from typhoid fever, the Salmonella Typhi might still be in your bloodstream. A high, sustained fever is the usual symptom, although typhoid sufferers can also experience stomach pains, headaches and a loss of appetite. In addition to observing the normal, common sense rules of hygiene, you should also be vaccinated against the disease (there are occasional outbreaks of typhoid in the Dominican Republic). You can either have an injection, which provides protection for three years, or a course of three oral capsules, which lasts for one year. Note that either option takes at least one week to take effect.
Hepatitis A is a viral disease which attacks the liver and usually causes jaundice. It is caught by consuming contaminated food or water as well as by direct person-to-person contact, which makes something as innocuous as not washing your hands after visiting a public lavatory a potential risk. Once again, hygiene and common sense are the keywords. Additionally, there are two ways to protect yourself against hepatitis A before departure. The best, although more expensive, option is the Havrix or the new Avaxim vaccine. The initial injection provides protection for about 12 months; the second dose, administered six months after the first, covers you for ten years. Note that these vaccines need four weeks to become effective. For short stays in the Dominican Republic, a shot of immune globulin (gamma globulin), which helps reduce - not eliminate - the risk for about three months, is cheaper. With this in mind, take the dose of gamma globulin as close to your departure as possible.
Hepatitis B is another serious viral disease which is present in the blood and body fluids of an infected individual. It also attacks the liver and can sometimes be fatal. Transmission is by unprotected sexual intercourse and unsterilized needles, which makes it less of an immediate threat to the average traveler than the more freely transmitted hepatitis A. The vaccine, administered in three intramuscular doses, provides protection against hepatitis B, although the precautions recommended to combat AIDS (also see AIDS below)apply equally when trying to minimize the risks of catching hepatitis B.
The decision whether or not to have the highly effective - but also expensive - rabies vaccine will depend on the nature of your trip. If you intend to have a lot of contact with animals, the vaccine is probably worthwhile. Rabies is carried by mammals - usually dogs - and is passed on to man through a bite, a scratch or a lick of an open wound. If you know or think that a rabid animal has assaulted you, go to a doctor without delay. In the interim, scrub the wound thoroughly with soap under running water for five minutes then pour on a strong iodine or alcohol solution. You might not eradicate the risk of rabies, but you will guard against wound infection and the very real risk of catching tetanus. Two post-bite rabies injections are then required, even for those who have been vaccinated against the disease. The closer the bites are to the brain the shorter the incubation period. Therefore, if the bites are to the face or neck, the two injections should ideally be administered within one week.